Atheroma

Question 1

Define atheroma, atherosclerosis, arteriosclerosis

Answer 1

Atheroma – The accumulation of intracellular and extracellular lipid in the intima and media of large and medium sized arteries

Atherosclerosis – The thickening and hardening of arterial walls as a consequence of atheroma

Arteriosclerosis – The thickening of the walls of arteries and arterioles, usually as a result of hypertension or diabetes mellitus

Question 2

Describe the micro and macroscopic appearance of atheromas

Answer 2

MACRO

• fatty streak
• simple (raised yellow/ white) plaque
• complicated (thrombosis, calcification) plaque

MICRO

• smooth muscle cell proliferation
• foam cell
• extracellular lipid
• fibrosis
• necrosis
• cholesterol clefts

Question 3

Explain some examples of severe atherosclerosis

Answer 3

• IHD
• cerebral ischemia (TIA)
• mesenteric ischemia
• PVD

Question 4

What are the risk factors for atheroma formation?

Answer 4

• age
• gender
• hyperlipidaemia
• cigarette smoking
• HTN
• DM
• ETOH
• infection
• lack of exercise
• obesity
• oral contraceptives
• stress

Question 5

Describe the unifying hypothesis of atherogenesis

Answer 5

• endothelial injury due to raised LDL, toxins, hypertension and haemodynamic stress
• endothelial injury causes platelet adhesion, PDGF release, SMC proliferation, monocyte migration
• foam cells secrete cytokines stimulating more SMC

Question 6

How can you prevent atheroma?

Answer 6

• smoking cessation
• dietary changes
• antihypertensives
• manage DM
• statin therapy